Prostate Screening’s Efficiency In The Elderly Questioned

By Anna Boyd
14:01, August 5th 2008
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Prostate Screening’s Efficiency In The Elderly Questioned

Prostate-cancer screening or the PSA test for men aged 75 or older should be stopped because there is more evidence of harm than benefit, according to a US advisory panel.

On Monday, the Preventive Services Task Force released a statement in which it updated its 2002 report by saying that more evidence is needed to determine if men under 75 could benefit from screening.

“Most prostate cancer grows very slowly, and many men with prostate cancer die of something else before the prostate cancer causes a problem. Early detection, however, puts men at risk for unnecessary worry and side effects of treatments,” such as impotence, incontinence and bowel problems, the task force said.

The PSA test measures a protein in the blood produced by prostate tissue. The test generally indicates the presence of a tumor but confirming it requires a biopsy. The measure has significantly increased the number of prostate cancer cases being diagnosed at very early stages, but there is no evidence to prove whether it translates into a reduction in death rate from the disease.

The 2002 report concluded there was insufficient evidence to recommend prostate screening for men of all ages.

Officials at several leading medical groups, including the National Cancer Institute and the American Cancer Society, praised the new guidelines. However, there were others criticizing them. Fore example, William J. Catalona, a professor of urology at Northwestern University thinks, “they’re really missing the boat. It’s a disservice to patients. A lot of men die from prostate cancer, and there’s just an overwhelming amount of evidence that screening saves lives,” he said.

Prostate cancer is diagnosed in approximately 220,000 US men annually and about 28,000 die of it, which makes it the most common cancer and second-leading cancer killer among men.

The new guidelines are supporting the findings of a study published early last month in the Journal of the American Medical Association, according to which widely used hormone-blocking drugs do not improve survival in older men with early prostate cancer that has not spread.

The hormonal drugs are used to suppress the testosterone that feeds prostate cancers and are usually given to the elderly although there is no scientific evidence that they really help. On the other hand, they have as most obvious side effect sexual dysfunction, but the therapy has been recently linked to greater risks such as diabetes, bone fractures, heart disease, reduced muscle mass, weight gain, hot flashes and decrease in mental acuity.

The study, conducted by researchers at the University of Medicine & Dentistry of New Jersey, analyzed thousands of medical records of men with a median age of 77 diagnosed with early prostate: 40 percent of which had received hormone therapy for an average of 18 month while the rest opted for watchful waiting.

The analysis found that nearly 20 percent of those on hormone therapy died of prostate cancer within 10 years compared with only 17.4 percent of those in the other group.

“Use of hormone therapy does not improve survival. The reason patients want this is they want something that will improve their quality of life or their survival. But hormone therapy has a detrimental effect on quality of life. And we cannot find any survival benefit for these men in their 70s with very early-stage cancer,” Dr. Grace Lu-Yao, lead author of the study, said at the time.

Given these findings, the task force recommended “larger, longer-term studies” to determine whether such measures benefit the old men. Also, the panel recommends that men “make a decision based on their individual risk factors and personal preference,” Dr. Ned Calonge, chief medical officer of the Colorado Department of Public Health and Environment and chairman of the task force, said.

The new recommendations can be found in this month’s Annals of Internal Medicine.



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